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Budget Debate : Health Hon AF Mahlalela 15 May 2018 in the National Assembly

The Hon House Chairperson/Ministers and Deputy Ministers, Hon Members, Cde's and Friends;

"Health is not everything, but everything is nothing without health". Those were words from the Indian Spiritual Master and Author of the System "Yoga Daily Life". Everyone will probably agree with him that "Health is human being's first happiness". And that is the essence of it all, should we fail to take care of our health, we will lose our happiness as well as our wealth. Our health is mostly influenced by the food we eat, our way of thinking, our relationship towards ourselves and the world, and the influence of the environment.

Section 27 of the Constitution enjoins us to ensure that everyone has the right to have access to health care services, including reproductive health care. It further stipulates that "the state must take reasonable Legislative and other measures within its available resources, to achieve the progressive realisation of these rights.

This constitutional imperative therefore urges government to ensure that there is Universal access to health services. To achieve Universal health coverage, institutional and organisational reforms are required in order to address structural inefficienciences; ensure accountability for the quality of the health services rendered and ultimately to improve health outcomes particularly focusing on the poor, vulnerable and disadvantaged groups.

The situation is further compounded by public health challenges, including the burden of diseases such as HIV and TB, shortage of key personnel and the dramatic growth of non-communicable or lifestyle diseases.

NHI is now undergoing the second phase of implementation though the extent of reform interventions of the first phase is still unclear as the department is still busy with the evaluation process. The APP is however silent on delivery timelines for setting-up the fund despite the pronouncement having been made in the 2017 budget speech by the Minister of Finance when he said "In the next phase of NHI implementation, an NHI fund will be established". According to that statement, the initial focus of the NHI fund will be:

  • To improve access to a common set of maternal health and ante-natal services and family planning services,
  • To expand integrated school health programmes, including provision of spectacles and hearing aids, and
  • To improve services for people with disabilities, the elderly and mentally ill patients, including provision of wheelchairs and other assistive devices.

The Minister further alluded that in setting up the fund, "we will look at various funding options, including possible adjustments to the tax credit or medical scheme contributions". We however understand that all these reforms will take place once the NHI Legislation is in place and hope that such legislation as promised by the President during SONA, will be tabled to Parliament.

There has been an observation that the bulk of the allocation in programme 2, National Health Insurance, Health Planning and Systems flows towards consultancy fees. There is therefore a need to build internal IT capacity as an important strategic goal going forward as the department rolls out its multiple e-platforms to reduce reliance on consultants.

  • Strengthening the fight against HIV and TB, through systematically implementation of the 90-90-90 strategy, non-communicable diseases by launching a nation campaign against cancer and intensify our efforts to reduce smoking; alcohol and Sugar consumption.
  • Improving human–resource management at state hospitals and strengthening coordination between the public and private health sector.
  • The department has managed to deploy "health teams" to communities and schools of which 3 519 WBPHCOT are currently established and functional as opposed to 3000 functional WBPHCOTs by 2019.
  • The health status of South African is rapidly improving, life expectancy has increased according to the Stats SA (in 2017) when shows that life expectancy had improved from 59,6 in 2009 to 62,5 years in 2014 and to 64 years in 2017. This represents a male life expectancy increased from 55 years in 2009 to 61,2 years in 2017 while female has increased from 58, 7 years in 2009 to 66,7 years in 2017. We are therefore confident that the department is on track and will be able to achieve the MTSF 2019 targets of 65 years.
  • The government consistent effort and focused plans to improve maternal, Child and Women's health have yielded positive results, which is consistent with the goals of the NDP 2030. According to Stats SA, infant mortality rate improved from a baseline of 42,8 deaths per 1000 live births in 2009 to 36,6 deaths in 2014, to 32,8 deaths in 2017 while under - 5 mortality rate improved from a baseline of 63,3 deaths per 1000 live births in 2009 to 49,1 deaths in 2014, to 42,4 deaths by 2017.
  • Number of people who tested for HIV has increased exponentially from a low base of 1, 4 million people in 2009 to 14,2 million in 2016. The rapid scale up of ART services has resulted in significant increases in the number of people receiving ART-in 2009, 1,1 million people were initiated on ART, this increased to 2,9 million in 2014, and then to 4,0 million people living with HIV being retained on ART by 2017, and there is an intension to add 2 million more by 2020.

We welcome the department's plans to screen and test 14 million people annually for HIV and related diseases. We however wish to encourage the department to continue with its efforts of directing most of its focus and energy on preventative measures by aligning its objectives to the HIV and AIDs (life skills education) grant under the Department of Basic Education.

We also want to commend the department on the TB treatment outcomes which have shown consistent improvement. The success factors for the impressive TB outcome indicators include improvements in the effectiveness and efficiency of the routine TB control programme, through interventions such as:

  • Intensifying the identification of TB patients;
  • Ensuring that TB patients take and complete their treatment;
  • Continuous training of TB tracing coordinator;
  • Effective tracing of TB patients and suspected TB patients and
  • Improving the functioning of the MDR-TB control programme, including through earlier initiation of treatment and decentralised treatment.

In relation to infrastructure, we wish to command the Department for its effort of repairing and/or refurbishment of 150 facilities in NHI Districts and its intention this financial to maintain, repair or refurbish 125 facilities in NHI Districts, construct or revitalised 2 hospitals and construct or revitalised 20 clinics and community Health centre.

Despite all these efforts, we are however concern that Health facility Revitalisation Grant and the indirect component of the National Health Grant is being reduced by R511 million and R309 million respectively for the 2018 MTEF, as this may likely affect departmental infrastructure delivery programme. We wish to encourage the department to redirect conditional grant allocations towards maintenance of infrastructure and equipment's in order to meet its target of ensuring that all facilities comply with the ideal clinic model. There's also a need to develop systems that ensures that provinces provide sufficient budget provision for absorbing qualified health Professionals especially nurses and doctors as part of their human capital plans.

Arising from the report of the health ombuds, there's a need to re-define what needs to be delivered at which level of government; and clearly state what needs to be delivered at the national level with a view to build a single, integrated national system. This should be done in order to address the inequitable distribution of health gains between and within Provinces as well as between public and private health sectors.

This will be in line with the preamble of the National Health Act (61 of 2003) as amended which states that one of its objective as: "To promote a spirit of co-operation and shared responsibility amongst public and private health professionals and providers and other relevant sectors within the context of national, provincial and district health plans".

There's an urgent need to pay special attention on the major issues that is currently bedevilling the public health system which are inadequate infrastructure for mental health services, which is impacting negatively on the quality of services; limited progress towards the implementation of the Ideal Clinic where 1 227 Primary Health Care facilities have achieved Ideal Clinic Status as opposed to the target of 2 823 target in 2019; there is a need to address the immense financial pressure that public health sector is currently experiencing which include the R28 billion worth of claims lodged as of July 2017 as well as R16 billions of accruals.

Despite these improvements in the mortality trends, the rates are still unacceptably high for a country like South Africa. Premature deaths, injury and violence and high absenteeism and presentisms due to poor health status contribute to low productivity at work and therefore slow economic growth.

According to global statistics, South Africans are among the highest consumers of alcohol. According to a statistical update from the WHO shows that in 2015, pure consumption (per litre) in South Africa is at 11, 5 litre per capita per year. The harmful effect of alcohol consumption in relation to health results towards violence, death and injuries through reckless driving, fatal alcohol syndrome, risky behaviours leading to the transmission of infectious diseases such as HIV and AIDs, neuropsychiatric disorders, cardiovascular diseases, and various cancers and has the ability to destroy families and disrupt communities. We welcome government efforts to reduce sugar consumption through the implementation of sugary drinks tax.

These social determinants of health create high levels of need for health care services, imposing immense pressure and heavy burden on the country's health system.

Thank you.

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